Facilitators and barriers of heart surgery discharge: patients’ and nurses’ narrative accounts

Background: Optimal patient recovery from open-heart surgery relies on effective discharge planning and education. However, the nature of the discharge experience has not been clearly described. Objective: The study purpose is to explore patients’ and nurses’ narrative accounts of the facilitators and barriers of heart surgery discharge. Methods: A qualitative study was employed using a narrative methodology that elicited and analyzed stories. This research was conducted in a large, urban hospital in Ontario, Canada. A total of 17 patients and nurses were recruited. Five female and 5 male patients were recruited from a preoperative clinic. Ages ranged from 37 to 80 years. Seven nurses were recruited from inpatient cardiovascular units. They had 2 to 19 years of cardiovascular nursing experience. Semistructured, narrative-based interviews were conducted. Two interviews were conducted with each patient at 1 week after discharge and at 4 to 6 weeks. One interview was conducted with each nurse. Results: Findings indicate that although the preoperative period was identified as an effective time for discharge preparation, the patient’s cognitive capacity was limited during the postoperative phase of surgery. Both nurses and patients also found that insufficient time impeded the discharge process and limited individualized discussions. The structured and standardized delivery of discharge information affected patients’ capacity to apply it to the particularities in their own lives and homes. The fostering of therapeutic relationships created a space where patients felt comfortable sharing their concerns and nurses learned more about patients and thus could better tailor the discharge approach. Conclusions: Study recommendations include group and scenario-based education in which patients and nurses brainstorm about how to apply the discharge information to the particularities of patients’ lives and homes. Provision of support needs to be bolstered during the home period, where patients have timely opportunities to discuss their concerns and questions with practitioners or possibly peers.

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The Role Of The Pediatric Nurse In Discharge Planning; Identifying Gaps In Sri Lanka

Indonesian Journal of Nursing Practices ◽

10.18196/ijnp.v5i1.10748 ◽

2021 ◽

Vol 5 (1) ◽

pp. 36-50

Author(s):

Kalpana Jeewanthi Subasinghe ◽

A.M. Shyama Deepanie Pathiranage

Keyword(s):

Sri Lanka ◽

Planning Process ◽

Transitional Care ◽

Discharge Planning ◽

Pediatric Population ◽

Discharge Process ◽

Sri Lankan ◽

Care Coordinator ◽

Pediatric Nurse ◽

Effective Discharge

Background: Pediatric discharge planning is a complex process, and that nurses need lengthy preparations. Role confusion among nurses will disrupt the smooth planning of the discharge. In Sri Lanka, although there is a possibility of reducing health costs through effective discharge planning led by pediatric nurses, it is questionable whether Sri Lankan nurses have clarified their role in this process.Method: This systematic review was conducted to map the different roles of nurses in the pediatric discharge planning process. Electronic databases of PubMed and CINAHL were searched for peer-reviewed journal articles among the pediatric population from 2005-2019, using the keywords such as discharge planning, pediatric nurse, care transitions, transitional care, and Sri Lankan nurse.Results: Articles that resulted in the word combination ‘Discharge planning and pediatric nursing (n=329) were used for screening. Two hundred and forty articles out of the nursing scope and sixty articles that do not describe an apparent nursing involvement in the discharge process were excluded, based on abstract review and full-text review, respectively. Sixteen studies were included in the final review. Few literature was found on the topic among Sri Lankan pediatric population. Four main categories of nurses’ roles were identified with the thematic analysis: discharge educator, discharge collaborator, post-discharge care coordinator, and family counselor. Conclusion: In Sri Lanka, no such defined roles of a nurse have been established yet in the discharge planning of pediatric patients. These roles may help nurses carry out discharge planning effectively, and future studies are needed on this topic in Sri Lanka.

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Psychiatric Discharge Process

ISRN Psychiatry ◽

10.5402/2012/638943 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Hamzah M. Alghzawi

Keyword(s):

Planning Process ◽

Discharge Planning ◽

Evidence Based ◽

Discharge Process ◽

Community Studies ◽

Inclusion Criteria ◽

Levels Of Evidence ◽

Effective Discharge ◽

Consensus Statements ◽

Acute Psychiatric Wards

Background. Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Discharge planning is an essential process in psychiatric nursing field, in order to prevent recurrent readmission to psychiatric units. Objective. The purpose of this paper is to perform literature overview on psychiatric discharge planning, in order to develop evidence-based practice guideline of psychiatric discharge plan. Methods. A search of electronic databases was conducted. The search process aimed to locate different levels of evidence. Inclusion criteria were studies including outcomes related to prevention of readmission as stability in the community, studies investigating the discharge planning process in acute psychiatric wards, and studies that included factors that impede discharge planning and factors that aid timely discharge. On the other hand, exclusion criteria were studies in which discharge planning was discussed as part of a multi faceted intervention and was not the main focus of the review. Result. Studies met inclusion criteria were mainly literature reviews, consensus statements, and descriptive studies. All of these studies are considered at the lower levels of evidence. Conclusion. This review demonstrated that discharge planning based on general principles (evidence based principles) should be applied during psychiatric discharge planning to make this discharge more effective. Depending on this review, it could be concluded that effective discharge planning includes main three stages; initial discharge meeting, regular discharge meeting(s), and leaving from hospital and discharge day. Each stage of them has requirements should be accomplished be go to the next stage.

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Posttraumatic Growth following Open-heart Surgery: The Role of Religious Coping and the Underlying Mechanism

PsycEXTRA Dataset ◽

10.1037/e576422013-001 ◽

2013 ◽

Author(s):

Amy Ai

Keyword(s):

Posttraumatic Growth ◽

Religious Coping ◽

Heart Surgery ◽

Open Heart Surgery ◽

Underlying Mechanism ◽

Open Heart

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Enhanced Effective Fibrinolysis following the Neutralization of Heparin in Open Heart Surgery Increases the Risk of Post-Surgical Bleeding

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645202 ◽

1990 ◽

Vol 63 (02) ◽

pp. 241-245 ◽

Cited By ~ 49

Author(s):

Jørgen Gram ◽

Thomas Janetzko ◽

Jørgen Jespersen ◽

Hans Dietrich Bruhn

Keyword(s):

Blood Loss ◽

Plasminogen Activator ◽

Heart Surgery ◽

Degradation Products ◽

Open Heart Surgery ◽

Tissue Type ◽

Tissue Type Plasminogen Activator ◽

Type Plasminogen Activator ◽

Chest Tube Drain ◽

Median Blood Loss

SummaryThe tissue-type plasminogen activator related fibrinolytic system was studied in 24 patients undergoing cardiopulmonary bypass surgery. The degradation of fibrinogen and fibrin was followed during and after surgery by means of new sensitive and specific assays and the changes were related to the blood loss measured in the chest tube drain during the first 24 postoperative hours. Although tissue-type plasminogen activator was significantly released into the circulation during the period of extracor-poreal circulation (p <0.01), constantly low levels of fibrinogen degradation products indicated that a systemic generation of plasmin could be controlled by the naturally occurring inhibitors. Following extracorporeal circulation heparin was neutralized by protamine chloride, and in relation to the subsequent generation of fibrin, there was a short period with increased concentrations of fibrinogen degradation products (p <0.01) and a prolonged period of degradation of cross-linked fibrin, as detected by increased concentrations of D-Dimer until 24 h after surgery (p <0.01). Patients with a higher than the median blood loss (520 ml) in the chest tube drain had a significantly higher increase of D-Dimer than patients with a lower than the median blood loss (p <0.05).We conclude that the incorporation of tissue-type plasminogen activator into fibrin and the in situ activation of plasminogen enhance local fibrinolysis, thereby increasing the risk of bleeding in patients undergoing open heart surgery

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The Hemostatic Mechanism after Open-Heart Surgery

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646707 ◽

1978 ◽

Vol 39 (02) ◽

pp. 474-487 ◽

Cited By ~ 2

Author(s):

E R Cole ◽

F Bachmann ◽

C A Curry ◽

D Roby

Keyword(s):

Extracorporeal Circulation ◽

Heart Surgery ◽

Polyacrylamide Gel Electrophoresis ◽

Open Heart Surgery ◽

Coagulation System ◽

Open Heart ◽

Time Activity ◽

Post Surgery ◽

Plasma Fractions ◽

The Mean

SummaryA prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p <0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p <0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p <0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.

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Blood Coagulation Studies and Extracorporeal Circulation in Man

Thrombosis and Haemostasis ◽

10.1055/s-0038-1655073 ◽

1967 ◽

Vol 18 (03/04) ◽

pp. 634-646 ◽

Cited By ~ 6

Author(s):

N Thurnherr

Keyword(s):

Blood Coagulation ◽

Extracorporeal Circulation ◽

Blood Clotting ◽

Heart Surgery ◽

Open Heart Surgery ◽

Fibrinolytic System ◽

Open Heart ◽

Clotting Factors ◽

Blood Clotting Factors

SummaryBlood clotting investigations have been executed in 25 patients who have undergone open heart surgery with extracorporeal circulation. A description of alterations in the activity of blood clotting factors, the fibrinolytic system, prothrombin consumption and platelets during several phases of the operation is given.

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Monitoring of r-Hirudin Anticoagulation during Cardiopulmonary Bypass – Assessment of the Whole Blood Ecarin Clotting Time

Thrombosis and Haemostasis ◽

10.1055/s-0038-1656078 ◽

1997 ◽

Vol 77 (05) ◽

pp. 0920-0925 ◽

Cited By ~ 139

Author(s):

Bernd Pötzsch ◽

Katharina Madlener ◽

Christoph Seelig ◽

Christian F Riess ◽

Andreas Greinacher ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Whole Blood ◽

Heart Surgery ◽

Ex Vivo ◽

Open Heart Surgery ◽

Clotting Time ◽

Blood Samples ◽

Alternative Approach ◽

Ecarin Clotting Time

SummaryThe use of recombinant ® hirudin as an anticoagulant in performing extracorporeal circulation systems including cardiopulmonary bypass (CPB) devices requires a specific and easy to handle monitoring system. The usefulness of the celite-induced activated clotting time (ACT) and the activated partial thromboplastin time (APTT) for r-hirudin monitoring has been tested on ex vivo blood samples obtained from eight patients treated with r-hirudin during open heart surgery. The very poor relationship between the prolongation of the ACT and APTT values and the concentration of r-hirudin as measured using a chromogenic factor Ila assay indicates that both assays are not suitable to monitor r-hirudin anticoagulation. As an alternative approach a whole blood clotting assay based on the prothrombin-activating snake venom ecarin has been tested. In vitro experiments using r-hirudin- spiked whole blood samples showed a linear relationship between the concentration of hirudin added and the prolongation of the clotting times up to a concentration of r-hirudin of 4.0 µg/ml. Interassay coefficients (CV) of variation between 2.1% and 5.4% demonstrate the accuracy of the ecarin clotting time (ECT) assay. Differences in the interindividual responsiveness to r-hirudin were analyzed on r-hirudin- spiked blood samples obtained from 50 healthy blood donors. CV- values between 1.8% and 6% measured at r-hirudin concentrations between 0.5 and 4 µg/ml indicate remarkably slight differences in r-hirudin responsiveness. ECT assay results of the ex vivo blood samples linearily correlate (r = 0.79) to the concentration of r-hirudin. Moreover, assay results were not influenced by treatment with aprotinin or heparin. These findings together with the short measuring time with less than 120 seconds warrant the whole blood ECT to be a suitable assay for monitoring of r-hirudin anticoagulation in cardiac surgery.

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